ASPEN Self-Assessment: Nutrition Assessment Flashcards
(T/F)
Catabolism of endogenous substrate including fat stored in adipose tissue (lipolysis) is common in both forms of malnutrition.
TRUE.
Hypoglycemia and ketosis are characteristic of starvation.
Hypermetabolism and hyperglycemia are characteristic of stress-related malnutrition.
Explain albumin.
A negative acute-phase protein.
Levels decrease in response to stress and hypoalbuminemia is more a reflection of the degrees of stress resulting from disease, injury, and inflammation than nutritional status.
Hypoalbuminemia has been associated with increased short-term mortality, length of hospital stay, and complications and correlates strongly with 30-day mortality.
Explain hyperhomocysteinemia.
Has been linked to an increased risk for coronary atherosclerosis.
Studies have shown that folic acid, vitamin B6, and vitamin B12 supplementation can reduce plasma homocysteine concentrations.
It is not known whether hyperhomocysteinemia is a causative factor of atherosclerosis or simply a marker of vascular disease.
What are the appropriate fluid requirements for each below?
- Healthy adults, aged 18-55
- Healthy adults, aged 55-75
- Healthy adults, older than 75
- Fluid restriction
- Healthy, aged 18-55: 35 ml/kg
- Healthy, aged 55-75: 30 ml/kg
- Healthy, older than 75: 25 ml/kg
- FR: Less than 25 ml/kg
Which amino acid is a key fuel for the small intestine?
Glutamine
It is essential for small intestinal structure and function.
Could be useful to supplement glutamine to patients who are suffering trauma or receiving PN.
What are two conditionally essential amino acids?
Glutamine & Arginine
- Other conditionally essential AAs are: Cysteine, glycine, proline, and tyrosine
- Conditionally essential AAs are synthesized from other AAs under normal conditions but require a dietary source in order to meet increased needs caused by metabolic stress.
(a) Example: Arginine becomes conditionally essential for wound healing.
Explain the recommendations for vitamin A deficiency with and without concurrent corticosteroid therapy.
For deficiency: 2,000 to 200,000 IU/day (606 - 60,600 RAE/day)
To counteract the inhibitory effects that steroids have on collagen synthesis and connective tissue repair: 3,000 to 15,000 RAE/day x 7 days orally
To enhance wound healing with concurrent corticosteroid use: 3,000 to 4,500 RAE/day orally
Zinc deficiency is most commonly associated with?
Diarrhea
The overall biochemical functions of zinc can be categorized as catalytic, structural, and/or regulatory in nature. Additional zinc is recommended in patients with additional losses from thermal injury, excessive GI losses such as diarrhea, decubitus ulcers, and high output fistulas
Copper toxicity is associated with what disease?
Liver Disease
- Copper toxicity can cause severe N/D/V. More serious manifestations with acute or more chronic toxic ingestion or Wilson’s disease include: coma, hepatic necrosis, liver failure, renal failure, vascular collapse, and death.
- Since about 80% of copper is excreted in the bile, patients who have liver disease should be monitored and supplementation reduced or eliminated.
- HD increases copper losses
- Enteral zinc supplementation can complete with copper for absorption.
What can result in an invalid IC measurement?
Chest tube leak
- IC is a respiratory measurement that under proper conditions is equivalent to metabolism, any factor that violates these conditions is a contraindication to IC.
- Examples: air leaks; extracorporeal membrane oxygenation(ECMO); HD; FiO2 > 60 in mech. vented patients; and for spontaneously breathing patients - reliance on supplemental oxygen; inability to cooperate with measurement, and claustrophobia or anxiety
-If RMR is the desired value to be measured (it usually is), then any factor that prevents that patient from being at rest or cooperating with the device operator is also a contraindication.
Explain REE.
Resting Energy Expenditure
- REE measured under steady stable conditions closely approximates true 24-hour energy expenditure.
- The addition of a stress or activity factor may not be necessary and could result in overfeeding.
- If a patient is measured while fasting or if feedings are intermittently provided, it is reasonable to allow an additional 5% factor to account for thermogenesis.
- Therefore, a critically ill patient’s energy delivery in response to REE does not need to be modified when measured by IC. AKA No stress/activity factors are needed.
Explain respiratory quotient (RQ).
RQ = CO2 produced/O2 consumed
Defined as the volume of CO2 released over the volume of O2 absorbed during respiration.
RQ <0.7 or >1.0 means?
Hypoventilation or hyperventilation
RQ of 0.71 means?
Primarily fat oxidation
RQ of 0.82 means?
Primarily protein oxidation